Provider Demographics
NPI:1134152580
Name:DONKERVOET, JOHN CORNELIUS (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CORNELIUS
Last Name:DONKERVOET
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 SAINT LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1920
Mailing Address - Country:US
Mailing Address - Phone:808-371-5539
Mailing Address - Fax:
Practice Address - Street 1:919 LEHUA AVE
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3328
Practice Address - Country:US
Practice Address - Phone:808-236-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI532350Medicaid
HI53235000OtherALOHACARE
HI0050240032OtherHMSA
HI0050240032OtherHMSA-QUEST
HI990298651-96706-C039OtherTRICARE
HI990298651-96706-C039OtherTRICARE
HI532350Medicaid